From the Guidelines
The dosage of Neoral (Cyclosporine) is up to 5 mg/kg/d, given in two divided doses.
Key Points
- The starting dose of Cyclosporine is typically 3 to 6 mg/kg per day with a maximum of 200 mg for both adults and children 1.
- In the context of glomerular diseases, the dose of Cyclosporine is up to 5 mg/kg/d, given in two divided doses, with a target 12-hour trough level of 60-150 ng/ml 2.
- The dose of Cyclosporine may need to be adjusted based on individual patient response and tolerance, with monitoring of trough drug levels to limit toxicity 2, 1.
- Cyclosporine has been shown to be effective in inducing remission in patients with idiopathic glomerular disease associated with the nephrotic syndrome, with response rates ranging from 60 to 75% 3, 4.
- The use of Cyclosporine in children with idiopathic nephrotic syndrome has also been studied, with reported remission rates of up to 82.1% 4.
- It is essential to monitor patients on Cyclosporine for potential side effects, including gingival hyperplasia, hypertension, nephrotoxicity, and nausea 1.
From the FDA Drug Label
The initial dose of cyclosporine [MODIFIED] should be 2.5 mg/kg/day. Cyclosporine [MODIFIED] should be taken twice daily, as a divided (1.25 mg/kg b.i.d.) oral dose. Patients should be kept at that dose for at least 4 weeks, barring adverse events. If significant clinical improvement has not occurred in patients by that time, the patient's dosage should be increased at 2 week intervals. Based on patient response, dose increases of approximately 0.5 mg/kg/day should be made to a maximum of 4 mg/kg/day. Dose decreases by 25% to 50% should be made at any time to control adverse events, e.g., hypertension, elevations in serum creatinine (≥ 25% above the patient's pretreatment level), or clinically significant laboratory abnormalities.
The dosage of Neoral (Cyclosporine) is 2.5 mg/kg/day initially, with possible increases to a maximum of 4 mg/kg/day.
- The dose should be divided into two daily doses.
- Dose adjustments should be made based on patient response and adverse events.
- The dosage may need to be decreased by 25% to 50% to control adverse events 5.
From the Research
Dosage of Neoral (Cyclosporine)
The dosage of Neoral (Cyclosporine) can vary depending on the individual patient and the specific medical condition being treated.
- According to 6, intravenous cyclosporine doses range from 2-9 mg/kg/d and oral doses range from 10-50 mg/kg/d.
- The dosage should be individualized based on the clinical status of the patient as well as blood concentrations of the drug 6.
- Monitoring cyclosporine blood concentrations is necessary in the postoperative management of transplant patients 6, 7, 8.
- A single concentration (C2) taken two hours after cyclosporine administration with the microemulsion formulation better predicts exposure and events than the trough concentration (C(0)) 7.
- The C2 level is considered a better reflection of immunosuppressive efficacy than the trough concentration 7.
- Target values for C2 levels have been proposed for liver and renal transplant recipients, but require further prospective validation 7.
- Neoral dose monitoring with C2 compared to trough levels (C0) has been shown to have clinical benefits in stable heart transplant patients 9.
- Dosages of less than 5 mg/kg/day rarely cause renal side effects 10.